Christa 0:00
Hello and welcome back to another episode of The Wild and well collective Podcast. Today, Cherie and I are going to be talking about lab work. And labs can be really confusing. Number one, because you may not even know what to order, what to ask of your doctor to order. Number two, there's a lot of confusion as to what is normal versus what is optimal. So today, Shireen, are going to go over some labs that you want to request. Because oftentimes I do find that when patients come to me from their primary care, they have very minimal pieces to the puzzle. So I like to look at lab work as, let's say, 100 piece puzzle, and when they show up with only 20 pieces, I'm like, Well, there's a lot of missing pieces here, so we don't really see the full picture. And so you might be getting that answer, well, all of your labs look normal, even though you don't feel well. And so this episode, we're going to be talking about what labs to actually request, and then we're going to go over some of the optimal ranges, because even if they look normal, it's not necessarily optimal for your optimal health. So some of the biggest heavy hitters that I want to address first is metabolic markers, and let's start with talking about lipids, because they can be really confusing. We can do an entire podcast on lipid cells, because there's so many sizes and shapes and what do they mean. But we're really going to focus on just two as far as lipids go, and that is triglycerides and HDL. Triglycerides are components of our their fat components. Our body basically uses that as storage. So when you maybe get your lipids checked and your triglycerides are elevated, it's not actually fat that's driving that number high. It's actually carbohydrates, processed foods, because the body has to convert that glucose into a storage form, and oftentimes that's stored as fat in the liver under triglycerides. So we want to pay attention to pay attention to that number. And optimal numbers for your triglycerides are going to be under 80 milligrams per deciliter. So under 80 is really the goal there, and then HDL is more of a bigger sized cholesterol. It's known as kind of the good cholesterol, and that's because it brings and collects other cholesterols throughout the body and brings it back to the liver for processing. So rather than sticking to the artery walls as some other smaller cholesterol molecules can, this one tends to kind of grab other cholesterols and bring them back to the liver. And so that's why we call it our good cholesterol. But it's important to have that a healthy number. So anywhere from 50 to 90 milligrams per deciliter is where you want to range that and a good ratio that you can do for yourself. When you're looking at, do I have metabolic disease? Am I storing more than I'm, you know, bringing in the good cholesterol? My story more triglycerides. You want to look at that ratio, and the ratio between triglycerides over the number of HDL. If you put those number on top of each other, you want the triglyceride. To HDL ratio to be 1.5 or below. If you do that ratio and that number is closer to three, you almost certainly have metabolic disease, which means your body's not really using energy for fuel appropriately. You're storing it appropriately. So that's my take on some cholesterol. And one thing that really can affect cholesterol is thyroid. Sheree, tell me what your take is when you're looking at lab work as far as thyroid. Because if our thyroid is not working well, our body isn't utilizing energy Well, which can lead to higher small particle cholesterols and triglycerides. Yeah, I think
Sheree 3:35
this is a great conversation. I think one of the biggest things that we quite often, just to give some context, when we get our blood results back, a lot of the time, it will say something like, your cholesterol was high. And then the first thing to go is take out the butter, take out the eggs, take out the foods. And like Chris has just explained beautifully, it's not actually the fats that are causing the issue. In fact, 80% of our cholesterol is even made by our body. Only 20% of it comes from our diet. And so when we start to muck around and mess around with this sort of thing, it's really important we look at it from a functional space and a functional approach. And like we've talked about numerous times, with empowered health being your superpower, we're not here pulling the doctors apart. We're just here going, let's look at your ranges before we end up seeing something like there's metabolic disease going on. Or let's use these markers as a source of empowerment so you actually understand and the I love the analogy you used Krista in terms of the 100 piece puzzle. And so often it is like labs are normal, or you've got these tiny little pieces. And if we know, for example, with like to circle to the thyroid, so often, all we get tested is our TSH, our thyroid stimulating hormone. And we really can't do much with that alone, right? We need to have a full thyroid panel for us to understand the full picture. We need to have your out phosphatase measured. As well, to look at your zinc, we need to be able to have your ferritin levels to look and your iron measured to see how that's affecting the thyroid, because there are so many micronutrients affecting the thyroid. And so when we have all these pieces to the puzzle, we're actually able to see a far clearer picture. And so if we think about the thyroid and the full panel that we love for our clients to order, and we quite often will request this specifically. We're looking at your TSH, yes, but we're also looking at your t4 your t3 and your free t3 so that you're getting an idea of the active hormones, the inactive hormones, and then what type of communication is going on between the brain and the thyroid gland and whether it's going to be supporting your metabolism to work effectively. Yeah,
Christa 5:41
optimal numbers. So TSH, for me. And really, you know, as Sri just said it, that is the brain hormone. That is a hormone that we're measuring to see how much output the brain is giving to the thyroid. That one I like to see 2.5 or below. So when it gets higher than that, that means, you know, the body's probably not seeing enough. T4 t4 is important, for sure. But most importantly, you want to know what t3 is, because our body has to convert t4 to t3 and t3 is really the active thyroid hormone. So definitely, always ask for t3 and then you want to break that down even further. You want to know you're free t3 because free t3 we have, we had a podcast with Doctor Amy Horniman, and we talked a lot about the thyroid there. If you're interested in just learning all about the thyroid, I think that would be a great podcast to to search and find. We can put that in the show notes too, if they wanted to bounce back to that. But free t3 is really the amount the hormone that's not bound to any protein, which means it's having active activity onto the cell. And you want that free t3 to be around 3.3 so I find when people are in the twos, 2.7 2.8 and they're tired, they probably need to supplement with thyroid, including not just Synthroid. You need to have a t4 and a t3 combination, like armor thyroid NP, thyroid until your body is healed. Sometimes people have Hashimoto thyroiditis, though, and that that healing never will really get fully there. And so to manage some of their inability with to produce energy, to manage their cholesterols and things like that, we need to optimize thyroid through a t4 and a t3 combination. One thing that you did mention with iron and ferritin, you do want to make sure that your ferritin is above 45 if you're going to be put on something that contains t3 otherwise you may experience more heart palpitations and symptoms of that. So that's just something to keep in your back pocket. As far as advocating for yourself with lab work, and
Sheree 7:37
when it comes to looking at the ranges, I think if we jump onto the ferritin, looking at ferritin, for example, this and just to give you guys some context, the ranges that Krista is talking through are the ranges that you'll see in US Lab work. So they do vary, because the units vary in that sort of thing across the globe. So just bear that in mind as we're talking through some of the ranges, and I'll be talking more to New Zealand and Australian ranges. But if we look at the ferritin, for example, that will start on a normal range, if, in terms of Doctor standards, from the 200 now, even if we're not looking at what the optimal ranges are right now, just let that sink in. You are technically okay if you fall between 20 and 200 and this is where we start to be more of an advocate for our health, because that is way too far of a scope. You need to know what your normal is. And also, again, if you're fitting in that optimal for again, in Australia and New Zealand, I focus primarily, especially if you're a menstruating woman, you should be having iron levels or stored ferritin levels around 80 to 90. You know, Krista mentioned for a minimum of 45 if you are having to take some form of medication for the thyroid and that sort of thing. But if we want to make sure we've got an abundance of energy, we're not dropping into that dizziness, or you're not feeling like you're lose if you are losing a whole lot of blood each month as well. There are so many factors when it comes to iron that we don't even think about. And we can be hovering around that 29 and that 30, but technically be classified as, okay, you don't need an iron transfusion or iron supplements because you're not low enough by the normal standards for us to actually do anything to support and this is where we like to look at things differently. This is where we like to approach things from a different lens. When it comes to that ferritin picture, it is really important, especially as women, to make sure you're in those optimal ranges. And anything higher than that, when we start to get over that 100, 110 120 we're looking at high levels of inflammation in the body. So it's all feedback. It's all feedback. If the body's holding onto iron, we want to know, why is the body doing that? Why are there high levels of inflammation, and start to dig a little deeper into the rest of the pieces of the puzzle.
Christa 9:43
Yeah, absolutely. Ferritin is iron storage, and it's definitely an inflammatory marker. If your iron in your blood is in a normal range, but your ferritin is high, that means your body is sequestering, like you said, your body does that as a protective mechanism to keep bacteria also. Like iron. So if your body feels there's inflammation, there's a threat, it will start to protectively put more iron into the storage form of ferritin, along the lines of red blood cells, CBC, the complete blood panel. One thing I want to point out for you to pay attention to. Now, this lab work. This a CBC is a pretty standard. You almost get this with every doctor appointment. Every lab order will include a CBC. But one thing I want to point out is the MCB, that's the mean corpuscular volume, and that's really the size of the red blood cell. The reason it's important to understand that is, if it's large, that could mean that you do need extra B 12. So a lot of people don't know that, but pay attention to MCV. I do like to see that number under 90. So if it's larger than that, then you know above 92 for sure that B 12 is required for now you know b 12 is required for a mature size of a red blood cell, and a mature size is actually smaller than than 90. So you want to pay attention to that number as well. When you look at a complete blood panel, moving on to another one of the metabolic markers, it's pretty obvious is fasting glucose. But I want to talk about fasting glucose as well as fasting insulin, because a fasting glucose should really be somewhere between ideally, optimally, between 70 and 80. Really, I say anything under 90 is probably means that your body is pretty efficient at moving glucose out of the blood system and into the cells again. That's fasting. So you're not doing workouts, you're not doing caffeine, you're literally drawing this blood lab first thing in the morning. So you want that definitely under 90, optimally 70 to 80. But more importantly than fasting glucose, this is where a lot of practitioners do not order, and this is where they fall short. Is you want to understand your fasting insulin. Insulin is a hormone from the pancreas that drives glucose out of the bloodstream and into the cell, and that's an important efficiency that we need to have in our body to utilize energy appropriately, and so we want that fasting insulin to be anywhere between two to five. Okay, that's milligrams per sorry, mius per liter, in whatever units you're looking at. But two to five is where you really want that number to be, certainly anything 10 or higher. If you get a fasting insulin, you're going to have to fight for this lab work to begin with, because a lot of doctors will say, Oh, we don't need to check in insulin. But you really need to understand that, because if your insulin is above 10, but your fasting glucose, which is commonly ordered, looks normal, they're never going to look at a fasting insulin. So you're not going to know that you're actually on the road to having high glucose. You want to catch this early. And so understanding insulin resistance, which means your body requires more insulin to do its job, to get the glucose into the cells, you want to know that early on, and if you have a higher insulin that's a that's an alarm system that you need to start paying attention to, how much processed food, simple sugars, are you eating, and how much are you moving your bigger muscles, which naturally utilize glucose, fasting insulin, and then I wanted to talk a little bit too about GGT and Alt, and you mentioned a little bit on liver enzymes and being zinc dependent. Can you expand a little bit on that and primary ranges that we want our liver also to be at? Yeah,
Sheree 13:19
I think this is a really important one, and it almost ties back full circle to when we're talking about some of those cholesterol markers, because a lot of the times, what we don't realize is that it's our liver that's overburdened, or our liver that's overloaded, and that's what's driving up the cholesterol, or Krista mentioned before. It can be the food or the dietary intake, or quite often, it's a combination of both. And so when we look at a liver panel, it's one of my favorite panels to look at, because it actually gives you so much information. We are looking at the out phosphatase and looking at that as a zinc marker, and how effectively the body is utilizing zinc and that sort of thing. And then we're looking at your liver enzyme. So we've got your alt, we've got your AST, and we've got your GGT. Now ideally those, especially if we're looking specifically at women's ranges and Kristy, you can touch on the variants that happens with men. We are trying to get you in those teens, like I personally love to see my clients between about 15 to 20, and when we start to dip low, just like we talked about with those MCV values, we can see that there may be a need for b6 or magnesium, specifically in something like your GGT or your gene, we can start to see what might be missing in your body, or in terms of nutrients to boost you up, these enzymes are massive, massive indicators that something's not right in your body. So when it comes to your liver health, those are some of the great ones we can really look at. And
Christa 14:37
alkaline phosphatase ALK, it's often or ALP, depending on what you're looking at. When it's low, it can mean you need zinc when it's high, though, that could also mean that there's some bile dysregulation, and so it's important to know your ranges there. I do like to see this number under 90, certainly, if it's under 50, that could mean that we've got some zinc deficiency, because it is a zinc dependent enzyme. But anything over. 90, I start to wonder, okay, do you need a little bit of digestion support? Even water with lemon can be helpful. But when those numbers rise, that can mean a little bit of thicker thickness in the bile, and that can lead to gallstones. It can lead to dysfunction in antimicrobial effect of the bile. So it's important to pay attention to that range as well. And yes, just as you mentioned, the alt, when the particularly alt is definitely from the liver, when that's high, and correlation with higher triglycerides or higher lipids, and we start to think fatty liver. So anything 20s or above, I start to get concerned about that. Now, these things can be transient as well. So I always recommend when you check these, if they're elevated, you want to check them about a month apart if they're elevated, because elevated, because sometimes medications, illness, viruses, alcohol, those can temporarily elevate these enzymes as well. So it's important to know where you're at and recheck if you do see those high, but also pay attention if they maintain high that it could be a sign of metabolic disorder and storing too much fat within the liver, irritating that that liver tissue, another lab value that I wanted to go over, and we should have looped this back up with glucose. But the a 1c and A 1c is a marker on the red blood cells hemoglobin. A 1c It's a marker that is extracted off of the hemoglobin of the red blood cell. And red blood cells last about three months before they're recycled. And so this really gives us a marker of how the what the average blood glucose, what the impact of blood sugar has been on that red blood cell over a three month period. So you really only want to check this about four times a year. You don't want to look at this more often, but it is ideally. You want to keep your a 1c or your average blood glucose under 100 and that looks like that number being five to 5.4 anything above 5.4 is on your way to pre diabetes. Now, normal range 5.7 or higher, they'll say, Okay, now you've got pre diabetes, right? Your blood sugar, your insulin, is really high. But when you are looking at your fasting glucose, and you're looking at an A 1c look at the insulin, and you'll know what path you're on. If your a 1c is really reflective of where you're headed. Okay, because even a fasting insulin within 5.5 let's say a 1c if you're fasting insulin is super high, you're on the way to that pre diabetes mark. So it's important to ask for all of those labs together so that you can see the complete picture behind the curtain of what's going on metabolically.
Sheree 17:24
And I think we've mentioned something a number of times that I just want to reiterate, is it does need to be fasted. Like a lot of the times I will see clients and it'll say non fasting, and I'm like, I can't actually do anything with this, because all it's telling me is how your body has responded to whatever meal, whatever workout, whatever cup of coffee you have, I don't even know, because there's no requirement to pop in what you had before your blood test. We don't actually know what's going on, so it is really important. And even your cholesterol markers can be affected by what you've had and that sort of thing. So going and getting your bloods done first thing in the morning on an empty stomach with nothing but water is going to be the key when you're wanting to get really accurate results for functional medicine practitioner to interpret, yeah,
Christa 18:06
and I wanted to wrap it up too with just two other inflammatory markers, because I think it's important to understand if you have simmering inflammation in your body, high sensitivity CRP is one that you can ask for, and this one will be elevated with generalized inflammation, and it can also mark, be a marker towards inflammation in the blood vessel lining, which is super important when we're thinking about cardiovascular disease, because the longer we have irritation in the red blood cells, the higher risk we are down the road to have arterial sclerosis, because that irritation creates little lesions, creates the need to create kind of a band aid inside of there, which then creates kind of these calcium blocks, right? So it's important to keep inflammation low so that there isn't this need for the band aid, which then down the line, later in life, can create a blockage. So CRP is one that you want to check at least yearly, and the ideally that marker is 0.3 milligrams per deciliter. If you're getting that in the high the twos to fives, that is too high, and so you need to pay attention if that number is elevated. That can be remedied by looking at processed oils, because processed oils can be inflammatory. Again, it's a metabolic marker, because if you've got high blood sugars, that's irritating to the blood vessel lining. So CRP is another important one to check at least yearly. And then finally, uric acid. I think most of us think uric acid. We think gout, right? That is true. A high amount of uric acid tends to accumulate into joints. The big toe, that kind of thing, is a gouty toe. That is a metabolic problem, because uric acid, more of it, is produced when we have problems utilizing energy in our body. Right? Uric acid can be protective, so we don't want that to be elevated, because that can be a signal to ourselves that our metabolism is off. So for men, you want to stay under five milligrams per deciliter. And for. Women, you want to stay between two and four milligrams per deciliter, and that's for uric acid. Again, another lab marker that a lot of times is not ordered, but it can be really useful to help you look at your overall inflammatory picture.
Sheree 20:15
I love that. And I think there was one more that we were going to touch on, which is the Creatinine. Now, again, this is another one that gets typically overlooked and almost contributes in the sense of metabolism. If we think about the importance of protein, the protein muscle synthesis to be able to look at the dietary intake of protein. Yes, you do get a protein marker in your liver panel, but I find creatine a little bit more effective in terms of giving real information. And so if I'm looking at these ranges, they should be sitting, typically around 70.7 all the way up to 97 and so most women, especially, I'll see this really low, they're not actually eating enough protein, or maybe they're not hitting the gym to actually maintain the muscle mass that they need to be having enough creatinine in their blood work. And so the other flip side of this that I see goes so wrong, because this is a technically a kidney marker, is that it goes really high. And I see this a lot in male clients because of the level of training that they might be doing, and there's so much more of that turnover of muscle that their creatinine levels jump right up. Now this is where you need to go to the doctor. And there's a couple of other couple of other tests you can request to make sure and rule out that this isn't a kidney issue and it's more a training issue. So if you are someone that is highly active and you are constantly but a lot of output, then chances are it's not actually an issue, and you don't need to do anything about it. It is literally just the body doing that muscle protein synthesis and turning everything over. But if you are on the lower end, it's a sign that you need to increase your protein intake and start to hit the gym a little bit more just to build that up again. So it's a really good little market for because we know muscle is our metabolic tissue. It is metabolically active, and so we can look at this from that perspective as
Christa 21:56
well. And then one more that I wanted to touch on is vitamin D. And yeah, you know, this one is included quite often yearly. But I think the ranges are very mismanaged. Optimal ranges. You really want to aim for your vitamin D to be close to 66, zero. And I think across the board, any practitioner who looks at labs regularly can say that there's a lot of people who are low in vitamin D. And the reason it's important to bring this up is vitamin D almost acts more like a hormone versus a vitamin meaning it sends signals to other areas of the body. And vitamin D is important for hormone regulation. It's important for the gut lining, it's important for our immune cells. So Vitamin D has a lot of jobs, and if we're walking around with our vitamin D, 23 milligrams per milliliter, you're really doing a disservice. And it's also kind of a signal. Sometimes, genetically, it can stay low because you're not converting well, which means you need a higher dosing, you know. But also it can be lower because the body is utilizing a lot of it because of inflammation. In any case, it's one piece to the puzzle. But I would say either through supplementation, through moderate sunlight exposure, you want to keep this vitamin D number closer to 60 milligrams per milliliter,
Sheree 23:11
yeah, and you see it like a lot of the time reflected, if people are low mood, we have seasonal affective disorder, like sad literally, people are lower mood, lower energy. We talk about how much happier we feel when the sun is out, and that's not a joke. That is, because it does help your body synthesize that vitamin D, and I think it's a really important marker, especially because a lot of places around the world don't get sunshine in high amounts, high doses, all year round, so we do need to supplement a lot, and the best time to test would be in the summer, but then also, again, in the winter, so you have an idea of the ranges and how your body works when there's optimal sunshine, and also when you may be a little bit more in the dark or in the cold.
Christa 23:49
Yep, yeah, Vitamin D is the basic so I hope this run through. I know this was kind of a fast and furious run through, but re listen to this if you found this interesting, and jot some of these numbers down and advocate for yourself to ask for these labs to be drawn if your insurance doesn't cover it. Sometimes you can go to a place that has cash pay options and you can get significantly lower pricing rather than them run it through insurance. So there are, I know, in the US, any lab test now, oftentimes has good pricing on lab tests that are cash pricing, but it's important to at least yearly look at the labs that we've discussed here, so that you have a better picture of the ranges that are optimal, and you have a better picture of where you are metabolically ahead of the game, ahead of the game before disease, ahead of the game before diabetes pops up or high blood pressure, etc. So I hope you found this helpful, and until next time.
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